For a patient with incurable or progressive cancer, good communication with a trusted oncologists is critical to appropriate decision-making, quality of life, and adjustment to illness. Yet, many have suboptimal communication skills because they have never had effective training. In this proposal, we describe a communications skill program for Medical Oncology fellows that is evidence-based, learner-centered, and curriculum-driven. Our program builds on successful existing programs in the US and UK, incorporates essential communication tasks for oncologists, and utilizes intensive skills practice and feedback. To teach this program, we have assembled an outstanding group of investigators and faculty who are nationally known for communications expertise and teaching ability. Finally, we have designed a rigorous evaluation that includes program review by international experts, self-assessment measures of knowledge, attitudes, and skills, and also impartial ratings of skill acquisition using encounters with standardized patient-actors. The specific aims of this proposal are to: Specific Aim 1. To develop a structured training program in communication near the end of life for medical oncology fellows using evidence based techniques Specific Aim 2. To implement a national 4 day course with follow-up distance mentorship for oncology fellows. Specific Aim 3. To evaluate the impact of the program on learner knowledge, skills, and attitudes using self-evaluation and audio taped performance with standardized patients. We have targeted Medical Oncology Fellows because their existing programs rarely include communications training, yet, they are interested and receptive to learning communication skills, and they are role models and teachers for residents and medical students. This program will create a formal curriculum for communication skills that could be replicated in many institutions to improve the quality of oncologists-patient communication--and ultimately the quality of cancer care--nationwide.